OBJECTIVES:  To describe the frequency and nature of SSA dose escalations among patients with advanced GEP-NET treated at a tertiary referral center. METHODS:  We conducted a cohort study of patients with GEP-NET recruited between June 2003 and May 2015 from Dana-Farber Cancer Institute’s (DFCI) and Brigham and Women’s gastrointestinal clinics, by linking an institutional research database to DFCI’s outpatient pharmacy dispensation data. Eligible patients had well-differentiated, metastatic GEP-NET and were seen ≥2 at DFCI. Dispensation frequency was categorized into weeks (dispensations +/-3 days considered part of the same week) and monthly SSA dosing regimens were derived. Dose escalations were defined as ≥2 increases in monthly SSA dosing regimens compared to last 2 SSA monthly regimens. Exposure gaps were dispensations separated by >6 weeks, with dosing regimens before and after the gap considered separately. RESULTS:  Among 682 patients (mean age [SD]: 58.5 [11.9], 50.1% male, 96.5% white, 44.9% midgut NET, 28.7% pancreatic NET, 26.4% other NET, 38.9% with carcinoid symptoms at baseline, and 62.6% with <1 year since metastatic GEP-NET diagnosis), 341 patients had >1 octreotide (long-acting release) LAR dispensation at DFCI’s pharmacy. No lanreotide dispensations were observed as lanreotide was not on formulary during the study period. Over 3.5 patient-years of octreotide LAR exposure, we observed 472 dose escalations among 213/341 (62.5%) patients (range: 1-9). Octreotide LAR dose escalations comprised increases in dose, increases in dispensation frequency, or both in 42.8%, 53.0%, and 4.2% of cases, respectively. The frequency of the most common dose escalations for derived monthly octreotide LAR regimens was 20.8% for 20 to 30 mg, 13.6% for 30 to 40 mg, and 13.1% for 40 to 53 mg (i.e. 40 mg/3 weeks). CONCLUSIONS:  Octreotide LAR dose escalations in the treatment of metastatic GEP-NET were common and may reflect an increased need for symptom control over the disease course.